One of the questions patients often ask is: “how does getting breast implants affect mammography and the ability to detect breast cancer?” I think this is a really good question and it shows a lot of thought has gone into whether a breast augmentation is the right operation for someone.

It is important to note that breast implants can affect mammograms, but this can be overcome if your radiologist knows you have breast implants ahead of time so that they can take additional special views of the breast which allow them to see much more of the breast tissue.  How this works requires a bit of background information on both mammograms and breast implants.  A mammogram is a special type of x-ray of the breast, and in order for it to work properly, the breast needs to be compressed between the two plates to make it as thin as possible for the x-rays to pass through the tissue easily and show if there are any abnormalities. Breast implants can interfere with mammograms in two ways: affecting the compression of the breast, and by blocking some of the x-rays. Because a breast implant is much denser than breast tissue, it cannot be compressed between the plates as well, and this means that the tissue around it can’t be compressed as much as it otherwise would have.

Breast implants – both silicone and saline – are “radiopaque” which means less transparent to the x-rays. A good way to think of this is that your breast tissue is like a glass window in a house – easy for light (or x-rays in this case) to get through so it is easy to see through. An implant acts like frost on that window – light can get still get through, but you can’t really see any details through it. On a mammogram, this looks like a white blob that prevents doctors from seeing what they need to see. That’s why special views were developed that use the plates to push the implant back towards the chest and compress the breast tissue around it, allowing doctors to see what they need to see. This acts like wiping the frost off the window.

How much breast implants affect mammograms also depends on where the breast implants are placed. When the implant is directly behind the breast tissue (subglandular) it is a little more difficult to displace than when it is behind the muscle (submuscular), so it can interfere a bit more. When implants are under the muscle, the breast tissue sits more on top of the implant and there is also a thick layer of muscle between it and the implant, so it can be separated from the implant more easily during a mammogram. Although it is not the only reason I prefer to place implants underneath the muscle, less interference with mammography down the road is one of the more important ones.

Patients who are worried, carry a higher cancer risk, have inconclusive mammograms or have had problems with mammograms before have other options. These other options include ultrasounds or MRI studies, both of which can be helpful to either detect or better characterize breast masses regardless of breast implant placement.